Talk:Pneumonia

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Why would it be bad to wikify PSS? --Sgeo | Talk 19:38, Sep 14, 2004 (UTC)

Contents 1 Fame and death 2 Other pneumonias 3 Diagnosis 4 Picture 5 Remaining weaknesses (?) 6 References 7 Fame 8 (unexplained) signs and more 9 MCOTW 10 Pneumonia navigational template 11 Provider vs. doctor 12 typo.. 13 Time for FAC? 14 copyrighted image 15 "Old Man's Friend" 16 Spontaneous Contraction 17 Aspiration Pneumonia vs. Aspiration Pneumonitis 18 CURB-65 article

[edit] Fame and death

I'm getting annoyed with the famous pneumonia sufferers. Pneumonia affects millions a day worldwide, and these people are not famous because they suffered from pneumonia. The list is bound to grow endlessly. Unless anyone objects, I will delete the list soon. JFW | T@lk 16:35, 3 Feb 2005 (UTC)

Hello. I beg to differ with your comments, Jfdwolff, of 3 Feb 2005. Have you ever had pneumonia? I did back in 1999 and I literally thought I was going to die. My point is that I was laid up for several weeks in recovery and I did alot of research on pneumonia.

It is a much more common cause of death than people ever realize and few of your friends and family or anybody really knows anything about it . . . try asking someone who likes factoids about what the celebrities on this list have in common and they will be amazed.

By keeping intact the section of famous pneumonia sufferers, people who suffer from it past and present can take comfort in that they are not alone. Further, readers of biographies on Wikipedia can link to the Pnemonia article as it is now and learn instantly of others who died a similar fate, and then link over to other articles to read those bios, etc.

Frustratingly, pneumonia sufferers have very little information to get at in today's popular press because it is not as interesting or novel a condition, nor is it as greatly studied as: AIDS, or MS, or Parkinsons, or ALS, etc. Have you seen the similar section of "Notable Parkinson's Sufferers" in the article about Parkinson's disease?--Are you as similarily annoyed with it?--I bet if you posted the same comments about that section on that article's talk area, you would probably get similar and doubtless more vitriolic reactions, from those that have contributed to that article. It's not just me interested in these links across history . . .

Thanks for not toying with the Pneumonia article as it is now, famous sufferers and all; I am telling you it is the best and most accessible one about pneumonia anywhere on the web--believe me, I've read them all. And thanks for your editing efforts at Wikipedia.

Respectfully submitted,

keane4 01:03, 4 Feb 2005 (UTC)

I'll leave it for now. Shall I add your name :-)? JFW | T@lk 13:34, 13 Feb 2005 (UTC)

Pneumonia is MCOW. I'm sure it will improve considerably this week with the increased attention from contributors. I'd like to make contributions later, but thought I'd raise one issue at the start so that regular and new editors of this article can discuss it and come to a decision.

The largest section of this article is, somewhat amusingly, "Notable people who've had pneumonia." Now, pneumonia is a medical subject, and there is an excellent guideline on Wikipedia Clinical Medicine on how to write these articles. Famous people with a disease is not a very prominent feature. Certainly, I think most reasonable people would agree that even if included, such tales are really asides, quirky trivia one mentions in passing, and not something so dominant that they actually take up 50 lines (the rest of the article is just 177 lines). JFW also raised the point that this appears to be an open-ended beast: most of the additions have been to this section, and it is entirely possible that it will soon be bigger than the rest of the article. Now, to be fair, part of the reason for this is that editors have not worked more on the medical part of the article — hopefully this will change over this week. But some decision has to be made about the "Famous people" bit. Strictly speaking, such trivia is actually "off topic:" I would not expect to see half my textbook on pulmonary diseases filled with trivia about who's had them, any more than I would expect to see a detailed explication of the pathogenesis of pneumonia in a book on trivia.

May I suggest a compromise? Let's agree to have the section, but limit it strictly to a few truly notable and interesting people. Say 5 historically-important, renowned people. Fair?—Encephalon | ζ | Σ 11:34:03, 2005-08-10 (UTC)

I'm not an expert in this area and my knowledge of pneumonia is extremely limited. I suggest that if we are going to keep this section, we arrange it alphabetically by the person's last name or chronologically by when the person passed away. I'm happy to do some clean-up here if others want to provide some input on what they prefer. Edwardian 16:22, 10 August 2005 (UTC)

I'd like to reserve this notability for people whose pneumonia itself was the subject of substantial public coverage. If George W. Bush aspirated a pretzel and developed aspiration pneumonia and died from it, that would be significant, as the press would focus on this sudden catastrophe in great detail, including sidebars by science editors and medical experts on television. This characteristic is missing from the present list, and to my chagrin it is growing quite rapidly. JFW | T@lk 16:32, 10 August 2005 (UTC)

I agree. I typically hate lists of this sort (and I know there are a lot of them!), but the section could be moved to List of famous pneumonia suffers with a link provided here for those people who MUST have this information. Do you think that would that be an acceptable compromise? Edwardian 16:50, 10 August 2005 (UTC)

Hear, hear. This list could potentially end up ridiculously long including every king, queen, philosopher, scientist, musician and so on that has ever had a serious case of pneumonia. Perhaps JFW's suggestion that only people who got significant public coverage of their coming down with pneumonia should be included. Alex.tan 17:22, August 10, 2005 (UTC)

Done. Created List of famous pneumonia suffers. Edwardian 00:17, 11 August 2005 (UTC)

Unfortunately mispelt 'sufferers' and so someone has set up a Vote For Deletion (VfD) - see Wikipedia:Votes for deletion/List of famous pneumonia suffers . I have added a suitable response to allow us to continue discussing the general policy on such lists, but we can't rename/move whilst it has the VfD tag ! -David Ruben 01:00, 11 August 2005 (UTC)

Sorry about the misspelling. FYI, someone else has moved it to List of notable people who suffer from pneumonia but it still has the VFD tag for those who care. Edwardian 04:09, 11 August 2005 (UTC)

I haven't seen the list, but Jim Henson died of it at a younger age than mine. Shortly afterward I felt quite ill and saw my doctor, who diagnosed a nearly admittable case of hilar pneumonia. It responded well to the cephalosporin of the decade. I think hearing about Henson's early demise from pneumonia prompted me to see my physician, and maybe saved my life. J.Schultz,R.N. 06:40, 5 November, 2005 (UTC)

I'd always heard that Jim Henson died of Strep toxic-shock syndrome. The internet doesn't seem to help InvictaHOG 14:57, 5 November 2005 (UTC)

[edit] Other pneumonias

Both viral and fungal pneumonias deserve some attention, particularly respiratory syncytial virus (RSV) pneumonia which is such a common cause of hospitalization in infants. MD2004 06:43, 9 Mar 2005 (UTC)MD2004

Go ahead, it's a wiki! JFW | T@lk 08:12, 9 Mar 2005 (UTC)

I created the fungal pneumonia page, still needs a short mention here I think. Viral pneumonia still needs to be done. --WS 01:22, 13 August 2005 (UTC)

Also created parasitic pneumonia page. --WS 11:23, 13 August 2005 (UTC)

And we have a viral pneumonia page now as well! --WS 20:20, 17 August 2005 (UTC)

[edit] Diagnosis

I don't disagree that xray consollidation does not confirm the diagnosis or does not help rule out other possible diagnoses, but...

• Is chest xray evidence of consollidation really the gold standard ? As a GP, I would have thought it is the confirmation of advanced or established pneumonia. If seen soon enough after onset, I would hope that expectoration to be keeping-up with sputum production, leading to only the occasional crackle heard and the patient not yet at the stage where large areas of the lung are consolliadated.
• History, examination for signs and the retrospective positive sputum-culture report would be the more typical confirmation triad in general practice.
• I dislike Xrays coming at the start of the 'Diagnosis' section as
  • GPs rarely need request it
  • Routine NHS community-Xray reports take 2 weeks to come from the hospitals/clinics (yes, awful I know)
  • It is not what patients in primary care normally need or should expect.
  • So sputum examination should come first, then Xrays, then blood counts for neutrophilia. Everything else is 'advanced' stuff that should be in a new paragraph

Please let me have your thoughts before I edit the "purity" of the Diagnosis section, but this encyclopedic article needs address pneumonia as the majority experience it, not the minority who need hospital admission. - David Ruben 21:24, 10 August 2005 (UTC)

My fault. Hospital docs get too geeky about this type of thing. Perhaps first things should come first: auscultation, percussion etc. JFW | T@lk 22:32, 10 August 2005 (UTC)

[edit] Picture

This article really needs a nice leading picture, something like this: [1] Anyone around that has good drawing/illustrating talents? --WS 15:26, 14 August 2005 (UTC)

I've been searching far and wide. The best pictures seem to be at the NIH Medical Encyclopedia, but in a particularly uncool move they subcontracted to A.D.A.M, which I think owns the copyrights.—Encephalon | ζ | Σ 15:59:17, 2005-08-14 (UTC) No suitable image at the CDC, by the way.—Encephalon | ζ | Σ 16:00:58, 2005-08-14 (UTC)

[edit] Remaining weaknesses (?)

• Complcations and differential need fleshing out.
• Epidemiology needs numbers.
• If anyone can find it, a diagram of a reeking, pneumoniard lung will be much welcome.—Encephalon | ^ζ  20:43:59, 2005-08-18 (UTC)
• In first paragraph: "Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites." Aren't the first three also parasites when they infect? --Zachbe 02:08, 20 December 2005 (UTC)

Parasites often mean something different in medicine when used in this way. Helminthes, cestodes, worms fall under the general term parasite. I dunno, if it's confusing it can be changed but it's commonly used in medicine even though it's inaccurate - InvictaHOG 06:48, 20 December 2005 (UTC)

[edit] References

I have removed all but one reference from the article as they were improperly cited and linked. Will work through them and add more.

Stored here for the moment.

1. ↑  National Guideline Clearinghouse. Guideline: Adult preventive health care: immunizations. In: National Guideline Clearinghouse (NGC) [website]. Rockville (MD), ©1998-2004. Cited August 30, 2005. Available: http://www.guideline.gov/summary/summary.aspx?doc_id=5616&nbr=3786&string

1. ↑  Centers for Disease Control and Prevention. United States, regarding vaccination with the pneumococcal polysaccharide vaccine (PDF)

1. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, et al: Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2000;31:347-82.

[edit] Fame

Keane4 put back a list of famous pneumonias. I repeat my assertion above that the pneumonia itself needs to have attracted signifcant attention to be intrinsically notable.

I'm also not sure about Further, pneumonia sufferers need this list! In what sense to they need it? Is this a form of celebrity therapy? Are breast cancer patients consoled by Kylie's illness? Honestly, I have my doubts. JFW | T@lk 01:22, 2 September 2005 (UTC)

• I agree, and obviously so do many others. (See Wikipedia:Votes for deletion/List of famous pneumonia suffers.) Edwardian 02:43, 2 September 2005 (UTC)

[edit] (unexplained) signs and more

the terms "dullness to percussion", "egophony" and "crackles" are unexplained and (were)unlinked. i think they need to be clarified - atleast to the extent that these are auditory signs (are they?). i find that these are elaborated in the Physical Exam section.

in the section Physical examination, are the words "able to speak in full sentences" meant to be "able to speak freely/continuously without difficulty in breathing?"

Doldrums 23:00, 10 October 2005 (UTC)

[edit] MCOTW

I'd probably hold off on copyediting the article for now. I plan on working on it a lot this weekend and I expect some sections to change as I add more references, data, etc.! InvictaHOG 11:21, 14 October 2005 (UTC)

I've been working on a few things so far. I think that general articles like pneumonia should make good use of linking to more substantial discussions of more specific subtypes. Unfortunately, there was no pre-existing articles on community acquired or nosocomial pneumonia. I've been working on CAP today, but there's going to be a lot more work before we can fill in all the gaps. I'm not happy with just listing the other kinds of pneumonia, especially as red links. I think that we should at least write short blurbs and then link to more substantial articles. The same is true for the complications. InvictaHOG 01:38, 16 October 2005 (UTC)

I've only got a few more sections to go with community-acquired pneumonia. I've been trying to find a well-designed page with content similar to pneumonia. Hepatitis is not one of them, but does show some features I'm interesting in exploring. I find it difficult to generalize about pneumonia - symptoms of one type of pneumonia aren't seen in others, etc. The article is quite slanted towards infectious (in particular bacterial) pneumonia. There's a good reason for that and the article makes it quite clear. However, I wonder if we might do better by acknowledging that pneumonia is an imprecise and unhelpful word, moving types of PNA up, fleshing out the discussion of different classifications, have full articles on bacterial, viral, fungal, lipoid, BOOP, etc. linked after short discussion. Then talk about point of care, bring in CAP and nosocomial. In the end, we'll have little use for much of the article, but can expand each section in the appropriate subarticle and not have to continually qualify each statement and discuss disease entities which are drastically different in the same paragraph. Pneumonia won't be feature status, but we could probably make runs with any of the subarticles. I think that bacterial pneumonia would be easy to compile with what we already have plus more on complications, etc. and would make a great feature article. Anyway, these are just my thoughts after wrangling with the content over the last week. I'm going to keep banging away on subarticles and hopefully finish CAP in the next few days - let me know if any of this sounds reasonable! InvictaHOG 03:46, 17 October 2005 (UTC)

What about making bacterial pneumonia the primary subject of the main pneumonia article, with brief explanations and links to articles for the other types? I think most readers would find that approach acceptable. Rewster 07:07, 17 October 2005 (UTC)

Many other non-specific terms such as arthritis, hepatitis, chest pain, uveitis, colitis, headache, etc. provide a general explanation of the term and spectrum of disease/diagnosis and then either list or discuss more specific types with links to articles. Honestly, it's hard to know what to make the focus of the main article pneumonia. Most people will personally experience community acquired pneumonia, which is often viral. I wouldn't want that to become the focus, though, because of the importance of nosocomial pneumonia for mortality, etc. I'm starting to lean towards the approach taken in the other general cases but will keep brainstorming for other ways to approach it! InvictaHOG 11:29, 17 October 2005 (UTC)

I hope to finish community-acquired pneumonia tomorrow. I'll start BOOP/COP and eosinophilic pneumonia thereafter. I've found quite a bit of interesting history, as well. I'm going to be expanding the complications as part of CAP. Depending on the direction people want to take on the main article, we can either start plugging things like complications in to pneumonia or writing up blurbs for the links to subarticles potentially over this next weekend. InvictaHOG 03:05, 18 October 2005 (UTC)

I finished CAP and various important antibiotics today and have just a little left on eosinophilic pneumonia. I'll work on a nice history section after that. I updated the prevention and plugged in the complications section. It's going to be tough to write the sections on treatment, epidemiology, prognosis, and pathophysiology. What is the prognosis of pneumonia? There will be too many qualifications to make it helpful. I'm going to experiment with different page layouts for pneumonia. What seems most logical (though I'm not a splitter, I swear!) is probably a pneumonia page with a discussion of the CAP/nosocomial PNA split followed by a discussion of infectious categories (bacteria/tuberculosis/PCP/viral/fungal/parasitic) followed by short blurbs on the non-infectious PNA (eosinophilic, COP, etc). Move specific diagnosis, treatments, epidemiology, prognosis and pathophysiology (other than simple alveolar damage and gas exchange deficits) to the respective categories. Stress how common CAP is, since that's the most likely lay experience with pneumonia. If anyone has a good idea of other ways to approach this let me know! InvictaHOG 02:44, 19 October 2005 (UTC)

I finished eosinophilic pneumonia tonight. Over the next few days, I'm planning to de-link bacterial pneumonia (unless someone objects!) from pneumonia and work on expanding epidemiology, prognosis, etc. for bacterial PNA in particular. If that works out, we can either copy the sections into the main pneumonia article or make major changes to the pneumonia section as suggested above. I will finish the history section tomorrow. InvictaHOG 02:16, 20 October 2005 (UTC)

I've been chopping some stuff out and adding some stuff in. Let me know if you think somethings needs to find its way back into the article. There is a lot of repetition and some things seem beyond the scope of the article. There's still the whole epidemiology, prognosis, etc. sections. InvictaHOG 02:36, 22 October 2005 (UTC)

I've reworked most of the sections and have pretty much reached the end of what I planned to do. I expect to make biographies for the history section tomorrow and finish up the last of the red links. I've reworked the lead image but can modify it further if anyone has any thoughts about it (or any of the other images, for that matter). Let me know if you think there's anything more that should be done to the article. InvictaHOG 02:59, 25 October 2005 (UTC)

Well, everything on the to do list is done. The article needs a good scrubbing and copyedit, now! InvictaHOG 17:17, 25 October 2005 (UTC)

Wow, InvictaHOG, you did some incredible work on this one. Nice anatomy image. I have resubmitted it for peer review to get some feedback especially from people with a non-medical background. Hopefully it can be a featured article candidate after that. --WS 23:43, 25 October 2005 (UTC)

InvicaHOG, you definitely deserve a break after this. Great work! Sorry I've been MIA; I intend to help out more with the peer review and FAC process. — Knowledge Seeker দ 04:10, 26 October 2005 (UTC)

[edit] Pneumonia navigational template

I just started the bacterial pneumonia page. As pneumonia is such a broad topic with a lot of articles for specific types, I think it might be a nice idea to start a navigational template with for all the pneumonia articles. I was thinking of something like Template:Suicide. --WS 11:48, 30 October 2005 (UTC)

I think a template is a great idea. Is there any general rules regarding when we use a side bar vs a template at the bottom of the page? Also, I was noticing how sparse the pulmonary sections were, knew that we had a GI template, and wondered what the general consensus was on this sort of thing...InvictaHOG 21:34, 30 October 2005 (UTC)

Couldn't find any guidelines for it. What do you think of something like this? --WS 12:45, 4 November 2005 (UTC)

I think it's hard to fit the long side bars into an article at times. It looks great, though! Going to add VAP InvictaHOG 12:54, 4 November 2005 (UTC)

[edit] Provider vs. doctor

In a medical article, the term "health provider" just doesn't sound right. "Health care provider" or "Healthcare provider" may be a bit better, perhaps more politically palatable and inclusive of the physician extenders: nurse practitioners and physicians' assistants. Personally, I am a doctor, and I hate being called a "provider." For medical articles, I would prefer we use "doctor," or "physician." (Or some type of compromise, such as "...doctor or healthcare provider....") What do others think? Rewster 07:26, 1 November 2005 (UTC)

I'm pretty uncomfortable with just saying doctor. There are so many entry points for health care that focusing on doctors is just not right. EMTs, nurses, NPs, PAs, etc. are all capable of diagnosing pneumonia (and other illnesses) and do so on a daily basis. Expanding to "doctor or healthcare provider" is pretty awkward...InvictaHOG 15:18, 1 November 2005 (UTC)

[edit] typo..

Up to 5% of patients admitted to an hospital

should be

Up to 5% of patients admitted to a hospital

Thank you for your suggestion! When you feel an article needs improvement, please feel free to make whatever changes you feel are needed. Wikipedia is a wiki, so anyone can edit almost any article by simply following the Edit this page link at the top. You don't even need to log in! (Although there are some reasons why you might like to…) The Wikipedia community encourages you to be bold. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. --WS 14:27, 2 November 2005 (UTC)

[edit] Time for FAC?

I am amazed by how much this article has improved. It looks very comprehensive to me, and I wonder if it's ready for a Feature Article nomination. However, I haven't been active in improving it and haven't been following the progress that closely, so I am unsure. What do others think? — Knowledge Seeker দ 05:47, 4 November 2005 (UTC)

When Rewster finishes with his fantastic copyediting, I'm all for it! InvictaHOG 12:23, 4 November 2005 (UTC)

Let's do it! :-) (only like to get the navigation template either in or out before that, see above) --WS 12:45, 4 November 2005 (UTC)

OK, made it an FAC. --WS 11:48, 14 November 2005 (UTC)

[edit] copyrighted image

Hi guys, I've removed this image from the text. It's from ACT Pathology, which is a "business unit of The Canberra Hospital, providing specialist pathology services to both public and private patients." [2]. Images from its website are not public domain. Furthermore, please note that it is mainly US government publications that are public domain (unless otherwise specified). Other governments hold differing copyrights over their works: the Crown copyright for the UK government, for example, is a lot more restrictive than the US government's. I'm pretty sure the Australian government's copyrights are similarly restrictive; I know we have had to delete a featured picture in the past because of Australian copyvio concerns. This is a shame, as Invicta has obviously put in a lot of work with the image. Getting public domain path specimen images is always a bit difficult; it might be best to try to get our own, from a non-anal path department. I'm out of luck there, I'm afraid. encephalon 13:27, 4 November 2005 (UTC)

That's pretty craptastic, but good that you found it before we went to FAC. I was just searching *.gov and thought I was safe. It's like that ADAM crap - I can't believe that government images are copyrighted. I'm working on getting a good path source, so hopefully there will be a replacement. InvictaHOG 00:18, 5 November 2005 (UTC)

I'll keep looking too—nice catch, Encephalon, and it's shame about all the work you put in it, InvictaHOG. — Knowledge Seeker দ 05:37, 18 November 2005 (UTC)

[edit] "Old Man's Friend"

I understand that the above term has been used in the past for pneumonia, in that a death by pneumonia is (relatively) less painful and faster than other causes of death in the elderly, especially compared to more degenerative diseases. I further understand that this term has had less currency as treatments for pneumonia have improved and pneumonia has lost ground as the (or at least a) leading cause of death in the elderly.

I've not contributed to a medical article before, so I'd appreciate any thoughts about how this information might be formatted and where inserted before I start mangling an otherwise excellent article. Thanks. JHCC (talk) 21:51, 7 December 2005 (UTC)

I thought about adding it after the other Osler quote in the history section. However, I somehow didn't think it was appropriate because a) it would require explanation and b) may still be construed as being insensitive by some. Since it didn't seem necessary, I kept it out. I wouldn't be opposed to its inclusion if it could be done right, however. InvictaHOG 22:17, 7 December 2005 (UTC)

JHCC, Right before the article went to review for FA, I slipped a few sentences in about prevention in infants. I wanted to put in a few more addressing end of life but, like you, I didn’t want to disrupt the flow. Below, verbatim from Merck, is more or less what I had in mind. I think this goes with Old Man's Friend. Could you condense it to a few sentences? We'll help edit it when you're done.--FloNight 00:03, 8 December 2005 (UTC)

http://www.merck.com/mrkshared/mmg/sec10/ch76/ch76a.jsp Section 10. Pulmonary Disorders Chapter 76. Pulmonary Infections Topics: Pneumonia End-of-Life Issues

Pneumonia in the elderly is often the terminal event of comorbid diseases such as diabetes mellitus, COPD, heart failure, malignancy, and dementia. Elderly patients with comorbidity are more likely to develop complications, eg, adult respiratory distress syndrome, empyema, and septic shock. In some cases, comfort measures may be more appropriate than antibiotics. Advance directives in such severe cases can often assist the physician in making appropriate decisions regarding resuscitative measures. When palliative care is the goal, opioids often help patients with dyspnea.

How about this, to go at the end of the History section:

In the elderly, especially those with other terminal conditions, pneumonia is often the immediate cause of death. In such cases, particularly when it cuts short the suffering associated with lingering illness, pneumonia has often been called "the old man's friend." As treatments for pneumonia in the elderly have improved, however, this term has lost some of its currency.

The Merck End-of-Life info is good, and perhaps should be included in Treatment section (which currently has no End-of-Life subsection), since this is current practice. If we do include it there, we can put a note in the "old man's friend" (should that be capitalized?) section: "See End of Life issues under Treatment." JHCC (talk) 15:38, 8 December 2005 (UTC)

I'm not sure that it would work best at the end' of the History section. If anything, it should be paired with the other Osler quote, attributed, and explained within the historical context, potentially adding a bit about its current role (honestly, while pneumonia is a leading cause of death in the West these days, I would never think to call it "the old man's friend." It so often leads to intubation, ventilation and then withdrawal that it's more like the "old man's flog.") I think that a section on end of life care under treatment would be nice, with discussion of the anticipated death by pneumonia in diseases such as ALS, DMD, etc. and the choice of comfort over treatment when pneumonia does occur. InvictaHOG 16:44, 8 December 2005 (UTC)

Discussion of comfort care e.g. in patients with terminal illness and pneumonia could end up opening up a Pandora's box! Andrew73 16:55, 8 December 2005 (UTC)

I know, I know. Some articles I can't imagine without addressing palliative care, of course. Things like pneumonia are less straight forward... InvictaHOG 17:10, 8 December 2005 (UTC)

The article gives the impression that Pneumonia is always aggressively treated for cure and that's not true. A few carefully written sentences explaining *choice of comfort over treatment* is needed to reflect reality. As the baby-boomer age, recognition of palliative care instead of treatment will become more common, otherwise, our health care system will collapse.--FloNight 20:00, 8 December 2005 (UTC)

I found an Archives of Internal Medicine article (February 10, 2003 (Volume 163, Number 3)) online [3] that gives a specific citation for Osler calling pneumonia "the Old Man's Friend" (Osler, W; The Principles and Practice of Medicine New York, NY: D Appleton & Co.;1898: 109-112) without, however, giving the full text of the quote. Thus, I'm not sure if Osler coined the term himself or was repeating an existing usage.

The online edition of the 1892 first edition of Principles and Practice states on page 526, "In the debilitated, in drunkards and in the aged the chances are against recovery. So fatal is it in the latter case that it has been termed the natural end of the old man." [4].

(It is interesting to note that, since Osler was writing before the antibiotic revolution, he states "Pneumonia is a self-limited diseases, and runs its course uninfluenced in any way by medicine. It can neither be aborted not cut short by any known means at our command" [5], but later notes "Pneumonia is one of the diseases in which a timely venesection may save life." [6])

On the other hand, the online edition of the 1901 fourth edition of Principles and Practice notes that the phrase "Captain of the Men of Death" was coined by John Bunyan to describe consumption and is appropriate for pneumonia as "the most widespread and fatal of all acute diseases" [7]. On page 131, Osler notes "So fatal is it in this country, at least, that one may say that to die of pneumonia is the natural end of old people" [8] (perhaps an early example of non-sexist language!)

(I note at this point that there is a collection of Osler's works online — not, I fear, as searchable text, but as scanned images — at The William Osler Collection.)

Furthermore, the Merck Manual, in its introduction to Section 3, Chapter 52 (Pneumonia and Influenza), includes the sentence, "Pneumonia [...] used to be called 'the old man's friend,' a quick way to death for an older person whose health was failing." [9]

While we personally might be disinclined to use the term ourselves, its use for over a century certainly warrants its inclusion in this article (pace InvictaHOG). JHCC (talk) 21:51, 8 December 2005 (UTC)

[edit] Spontaneous Contraction

My Dad always gets mad at me if I work out in the cold (-15C or so) with just a T-shirt. If you are working hard enough your body is generating enough heat to not really be effected by the cold, but he seems to think that it's dangerous and that I will contract pneumonia and die.

Specifically he refers to a story of a guy who did the same thing, he worked in -20 degree weather without a shirt on, but had a very high body temp from the work. In fact he felt that he was hot enough that he jumped into the snow to cool off, at which point his body temp plummetted, he instantly caught severe pneumonia, and died of it within hours.

This seems ridiculous to me, but he seems to beleive it.

So is this possible? After reading that pneumonia itself is not an infection, either viral or bacterial, but instead has a wide variety of causes, I can't quite rule out his story.Sahuagin

It's not really likely to have been related to the heat/cold if he did get sick after the incident you're describing. InvictaHOG 01:54, 30 May 2006 (UTC)

[edit] Aspiration Pneumonia vs. Aspiration Pneumonitis

Aspiration pneumonia and aspiration pneumonitis are clinically different things. I feel as though the distinction between the two should be discussed in this article. Paul Marik has a wonderful article describing the difference between the two in the The New England Journal of Medicine March 2001. (http://scalpel.stanford.edu/articles/aspiration--NEJM.pdf) —The preceding unsigned comment was added by Kewla6 (talk • contribs).

I think that it's beyond the scope of this article - there was orginally a discussion of it with that article as a reference, but it was just not helpful for a general article. Certainly, the aspiration pneumonia article is quite shabby and should certainly contain information about the distinction. InvictaHOG 18:30, 12 August 2006 (UTC)

Yes, I understand your point, but I still feel that the following statement is misleading. "Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating oral or gastric contents, either while eating, or after reflux or vomiting." It is my intention to add to the current aspiration pneumonia article about this issue.—The preceding unsigned comment was added by Kewla6 (talk • contribs).

[edit] CURB-65 article

There is a pneumonia related article called CURB-65. It is really weak, and even as a subject matter does not seem to warrant an entire article. Perhaps the info contained therein should be merged with this one, and a redirect set up. --Jayron32 03:44, 27 September 2006 (UTC)

The CURB-65 score is only one of many severity scoring systems for pneumonia. If you merged all the articles on scoring pneumonia severity into the pneumonia article, I think you'll end up with something bloated and not very useful. I suggest adding a link from pneumonia to CURB-65 and mentioning that it is now a standard part of the assessment of pneumonia severity in the UK. Also, the CURB-65 scoring system is only used in the UK, so is it really appropriate to be including it as part of the pneumonia article? I feel that would simply make the pneumonia article less encyclopaedic. I don't feel there is anything wrong with leaving the CURB-65 article where it is: it is a short article, but it says what it needs to say and is not a stub. --Gak 18:34, 3 October 2006 (UTC)